Provider Demographics
NPI:1386799351
Name:ACOSTA, LORRE LYN (MA CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:LORRE
Middle Name:LYN
Last Name:ACOSTA
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:MRS
Other - First Name:LORRE
Other - Middle Name:LYN
Other - Last Name:TODD ACOSTA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA CCC-SLP
Mailing Address - Street 1:345 AVENUE E
Mailing Address - Street 2:
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90277-5158
Mailing Address - Country:US
Mailing Address - Phone:310-930-2345
Mailing Address - Fax:
Practice Address - Street 1:345 AVENUE E
Practice Address - Street 2:
Practice Address - City:REDONDO BEACH
Practice Address - State:CA
Practice Address - Zip Code:90277-5158
Practice Address - Country:US
Practice Address - Phone:310-930-2345
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2016-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP9723235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist